Supreme Court Declines to Pause Order on Federal Prison Hormone Therapy

The Supreme Court on October 21, 2026, denied the Trump administration’s emergency request to enforce a Bureau of Prisons policy ending hormone therapy for transgender inmates. A federal judge’s order blocking the policy remains in place while the lawsuit continues. Justices Thomas and Alito would have granted the request.

The dispute is one of several federal cases testing how courts review policies on gender-affirming care, a subject our transgender history and education hub places in wider context. This report, updated October 22, 2026, draws on the Supreme Court’s docket and on SCOTUSblog, Associated Press and Advocate coverage. It reports on an emergency-docket order and is not legal or medical advice.

What did the Supreme Court decide?

On October 21, 2026, the Court denied the Trump administration’s request to pause a lower-court order that keeps a Bureau of Prisons policy from taking effect, in a brief, unsigned order that gave no reasoning.

The case is an emergency application, Trump v. Kingdom, No. 26A416. According to the Supreme Court docket for No. 26A416, the application was submitted to Chief Justice John Roberts on September 28, 2026, and he requested a response by 4 p.m. EDT on October 8. The docket shows the respondents, led by Alishea Sophia Kingdom, filed their response that day, and that the government filed a reply on October 9. Amicus briefs were also filed on October 8 by America’s Future and by a group of states led by Indiana and Idaho. The docket entry for October 21 reads: “Application (26A416) for stay presented to The Chief Justice and by him referred to the Court is denied,” and records that Justice Thomas and Justice Alito would grant the application. SCOTUSblog’s report on the order noted that the Court acted 12 days after the government’s reply and did not explain the timing, and the Associated Press account on PBS NewsHour likewise reported that the order gave no legal reasoning.

A stay application is a request to suspend a lower-court order temporarily. It asks the Court to decide who should bear the effects of the dispute while the case proceeds. Denying one is not a ruling on whether the policy is lawful.

What does the Bureau of Prisons policy do?

The policy, issued in February 2026, ends hormone therapy and certain social accommodations for transgender inmates in federal custody.

As SCOTUSblog (Amy Howe) reports in its report on the inmates’ response, the policy would end hormone therapy and “social accommodations” such as makeup, wigs, and padding. The Advocate reported that it bars new hormone treatment, directs clinicians to taper existing prescriptions, removes gender-affirming clothing and accommodations when practicable, and prohibits gender-affirming surgery while leaving treatment for complications from earlier surgeries available. The Associated Press account adds that mental health therapy continues.

The agency says it adopted the policy independently of a February 2025 policy that implemented President Donald Trump’s January 2025 executive order on federal funding for inmate medical treatment. In a 43-page memorandum, according to SCOTUSblog, the Bureau said earlier policies had relied on recommendations from the World Professional Association for Transgender Health that prison administrators found “unreliable” and “unpersuasive.” The memorandum also cited concerns about inmate attacks, fairness, and resentment among other inmates.

The Bureau said in 2025 that it was providing hormone therapy to more than 600 inmates, the AP reported.

How did the case reach the Supreme Court?

Three transgender inmates sued in 2025, a federal judge in Washington blocked the policy in August 2026, and a divided appeals panel declined to pause that order.

Three transgender people, represented by the ACLU, its D.C. affiliate, and the Transgender Law Center, filed the lawsuit in March 2025 and sought to proceed as a class, according to The Advocate. SCOTUSblog reports that on August 26, 2026, Senior U.S. District Judge Royce Lamberth barred the Bureau from implementing the 2026 policy. The AP notes that President Ronald Reagan nominated Lamberth. On September 18, 2026, a divided panel of the U.S. Court of Appeals for the D.C. Circuit denied the government’s request to pause his order.

Earlier in the litigation, The Advocate reports, Lamberth found the inmates likely to succeed on claims under the Administrative Procedure Act, the federal law governing how agencies make decisions, and left their Eighth Amendment claims unresolved. The AP reports that Lamberth wrote that the Bureau does not dispute that gender dysphoria can cause severe effects, including depression, anxiety and suicidal thoughts.

Because the order was left in place by the appeals court, the Supreme Court’s October 21 denial leaves it in effect while the lawsuit continues. For readers following similar disputes, our earlier report on a Ninth Circuit ruling on housing transgender women in Oregon prisons covers a different case about prison policy.

What does the government argue?

The government argues that the Bureau acted within its authority and that the district court gave prison administrators too little deference.

In its application, Solicitor General D. John Sauer argues that the district court substituted its own policy judgment for the Bureau’s, relied on evidence outside the administrative record, faulted the agency for following presidential directions, and denied prison administrators the deference they are due, SCOTUSblog reports. The Advocate reports that the administration also contends the injunction exceeds limits set by the Prison Litigation Reform Act, and that the Bureau reconsidered its policies based on medical evidence and security concerns.

In the AP’s summary, the Bureau determined that surgeries, hormone interventions in general, and social accommodations “could no longer be justified as treatment for gender dysphoria.” The executive order behind the broader federal approach directs that federal funds not be spent “for the purpose of conforming an inmate’s appearance to that of the opposite sex,” as the AP quotes it.

What do the inmates argue?

The inmates argue that the Bureau did not give the reasoned explanation federal administrative law requires and that pausing the order would cause serious harm.

According to SCOTUSblog, their attorney, Li Nowlin-Sohl, told the justices that the record does not address the Bureau’s own experience providing hormone therapy and social accommodations, or whether those treatments were effective or harmful. The attorney argued that the Bureau replaced long-standing treatment with psychotherapy and psychotropic medications that, in the Bureau’s own medical director’s account, treat co-existing conditions rather than gender dysphoria itself. The filing also argues that the omission of key evidence suggests the stated rationales were built to support the executive order, and that a pause could risk worsening gender dysphoria, depression, anxiety, self-harm and suicidality.

Nowlin-Sohl told the justices the government is asking them “to overturn a three decades-long status quo.” ACLU attorneys have also called the policy a “direct threat to the well-being of transgender people in federal custody” and argue that withholding necessary care amounts to cruel and unusual punishment, the AP reports.

How has the Supreme Court handled related disputes?

The Court has ruled for the government in some transgender-related cases and, in others, has allowed policies to take effect temporarily.

The AP notes that the justices have previously upheld state bans on certain treatments for transgender youth and restrictions on transgender athletes in women’s sports. It has also allowed, on a shorter-term basis, Trump administration policies on transgender military service and passport sex markers. Each of those matters involved different legal questions, so the outcomes do not map neatly onto one another. The October 21 order concerned an agency policy in federal prisons and the standards for a stay, and because the Court gave no reasoning, it does not settle the legal questions in the underlying case.

Background on the legal and medical terms used in these cases is collected in our reference library FAQs, and our research section gathers material for readers who want to go further.

What happens next?

The lawsuit returns to the lower courts, and the Bureau’s policy stays blocked while it proceeds.

With the stay denied, Judge Lamberth’s order remains in effect. The coverage reviewed did not describe the next steps in the litigation, such as any merits appeal or class certification, and it did not include a public response from the Bureau or the Justice Department beyond their court filings. A denial of a stay is not a final ruling on the policy: the Court gave no reasoning, and the underlying claims remain to be decided in the lower courts. Readers following the case should check court dockets for developments, because this page reflects coverage only through October 22, 2026.

Frequently Asked Questions

Has the Supreme Court ruled on the prison hormone therapy case?

It ruled on the emergency request, not on the merits. On October 21, 2026, the Court denied the government’s stay application in a brief, unsigned order that gave no reasoning. Justices Thomas and Alito would have granted it.

What is Trump v. Kingdom?

It is the Supreme Court’s name for emergency application No. 26A416, in which the government asked the Court to pause a lower-court order blocking a 2026 Bureau of Prisons policy on gender dysphoria treatment. The Court denied the request on October 21, 2026.

What does the Bureau of Prisons policy change?

Coverage describes it as ending hormone therapy and social accommodations such as wigs and makeup, and prohibiting gender-affirming surgery, while mental health therapy continues.

Who blocked the policy, and when?

Senior U.S. District Judge Royce Lamberth in Washington barred the Bureau from implementing it on August 26, 2026. A divided D.C. Circuit panel declined to pause that order on September 18.

What does a stay of the order mean?

A stay would have temporarily suspended the lower-court order while the lawsuit continues. Because the Court denied it, the order stays in effect. The denial does not decide whether the policy is lawful.

How many inmates receive hormone therapy in federal prisons?

The Bureau said in 2025 that it was providing hormone therapy to more than 600 inmates, according to the Associated Press. Current figures were not available in the coverage reviewed.

Does the Supreme Court’s order end the lawsuit?

No. The case continues in the lower courts, and the Bureau’s policy remains blocked in the meantime.